The Mediating Role of Media Internalization in Body Scrutinization and Body Image Dissatisfaction in Thai Homosexual Male Youth

The debilitating impact of body image dissatisfaction has been well-documented, leading to attempts to propose ways to alleviate the dissatisfaction. These proposals are drawn primarily from findings from studies on female youth. The current study extends this work, and contributes to an emerging initiative to attempt to reduce body image dissatisfaction in homosexual male youth. Past empirical findings have identified these adolescents to be particularly prone to body image dissatisfaction. With the formal operational stage of cognitive development, adolescents are particularly self-conscious and scrutinize their body image more critically, leading to body image dissatisfaction. The aim of the current study was to identify a potential protective factor that might help reduce the impact of body scrutinization in Thai homosexual male adolescents. These participants were selected due to the relative lack of published research on body image in Asian homosexual males. Additionally, despite its orientation toward the collectivistic fulfillment of social roles and obligations, Thai culture is quite accepting of sexual minorities. Homosexual male body image ideals are portrayed in the media with relatively high frequency. For this reason, internalization of media influence was selected as a potential mediator of the relationship between body scrutinization and body image dissatisfaction. Data were collected from 114 Thai homosexual male youths who responded to online questionnaires measuring body scrutinization, media internalization, and body image dissatisfaction. As hypothesized, findings demonstrated that body scrutinization significantly predicted both body image dissatisfaction and media internalization. Media internalization significantly but partially mediated the relationship between body scrutinization and body image dissatisfaction. Implications were discussed in terms of the preventative and therapeutic potentials for reducing media influence on body image dissatisfaction when the scrutinization was engaged.


Introduction
A substantial research literature has shown that body image, a subjective evaluation of one's physical appearance (Thompson et al., 1999), is of particular importance during adolescence the developmental stage at which individuals are generally expected to achieve the epitome of ideal physical appearance. Reaching the formal cognitive development stage (Piaget, 1964), youth also become more aware of societal expectations and, hence, more conscious of their physical appearance. Hence, body image dissatisfaction is reported to be particularly distinctive in this developmental stage, leading to various debilitating physical and psychological impacts. These include the development of unhealthy eating and weight loss habits as well as psychological disorders such as anorexia or bulimia nervosa, and binge eating disorder (Stice and Whitenton, 2002).
To date the focus of research has been primarily on heterosexual female body image dissatisfaction; and recognition has only recently emerged that gender orientation is also a major factor to consider in the study of body image dissatisfaction. For example, in contrast to the emphasis on achieving the "thin ideal" in females, findings indicate that an increase in muscle enhancement is the preferred aim in males (McCabe and Ricciardelli, 2004). Additionally, whereas body image dissatisfaction was found to be lower in heterosexual males when compared with females, the dissatisfaction was higher among homosexual males than their heterosexual counterparts and indeed comparable to heterosexual females. When compared with their heterosexual counterparts, homosexual males gave a higher emphasis on being muscular and trimmed (Boroughs and Thompson, 2002;Conner et al., 2004;Duggan and McCreary, 2004). Given these differences in body image ideals and socio-cultural expectations, the question is whether research findings concerning the extent of body image dissatisfaction in heterosexual females could in principle be true of individuals with different gender orientation, particularly homosexual males. As previously mentioned, this sexual minority group was reportedly plagued to a comparable degree by body image dissatisfaction as heterosexual females (Beren et al., 1996) Despite the recent recognition of the importance of gender orientation, the investigation of body image dissatisfaction in homosexual males remains relatively limited. Most of the existing literature is drawn from Western cultures, where the sense of individualism is posited to be strong and influential. However, relevant findings in non-Western cultures, particularly Asian, where collectivist influence is stronger, remains largely unresearched (Ojanen, 2009).
With the strong sense of collectivistic obligations to fulfill social roles (Zhang et al., 2011), existing empirical evidence suggested that challenges encountered by sexual minorities in collectivistic cultures are likely to be particularly strenuous due to homosexuality-related stigmatization (Liu et al., 2011). Additionally, the deeply embedded collectivist culture is likely to produce pressure within the individuals to conform to ideal group norms for social self-presentation, including body image portrayal and behaviour. Therefore, the challenges encountered by Asian homosexual males might be aggravated by body image concerns. These could negatively impact their adjustments and warrants further research investigations.
The current study, therefore, was designed to fill the knowledge gap in body image dissatisfaction in homosexual male youth in an Eastern collectivist culture. We chose Thai homosexual male youth as the target group for further investigation. Thai culture has generally been posited to be relatively receptive of homosexuality (UNDP, 2014) and gender minorities are commonly portrayed with relative acceptance in the Thai media. Indeed, homosexual males have been identified as the sexual minority group most frequently publicized (i.e., when compared with lesbian, transgender, bisexual, and queer, respectively). When further examined, the majority of the media portrayals of homosexual males was related to fashion and popular culture. For these reasons, we chose to examine the degree to which Thai male homosexual youth internalized media influence. With the relatively tolerant Thai culture, we hoped that participants would be quite open to describing their experience of body image dissatisfaction.
The aim of the study was to examine the relationship that body image dissatisfaction has with body scrutinization and media influence internalization in homosexual male youth. Body scrutinization refers to the degree to which individuals became vigilant of their physical appearances to identify flaws and imperfections. Such scrutinization was one of the key factors that were consistently identified as contributing to body image dissatisfaction in recent research. Based on Self-Objectification Theory (Fredrickson and Roberts, 1997)., the scrutinization as captured by McKinley and Hyde's Body Surveillance Subscale of the Objectified Body Consciousness Scale (McKinley and Hyde, 1996) reflected the individuals' internalization of the societal demands for maintaining their physical appearances in accordance with these standards. Having reached the developmental stage of formal operations (Wadsworth, 1996), youth was particularly prone to scrutinize their physical appearance to evaluate if they measured up to societal standards. Anticipations of others' evaluations of their appearances were likely to lead to enhanced appearance self-consciousness. These comparisons and anticipations were reported to increase the their body scrutinization and the likelihood that they would detect flaws and limitations in their physical appearance. The scrutinization has been shown to be positively associated with body image dissatisfaction in female adolescents (Grabe and Hyde, 2009).
With their body scrutinization, youth is likely to be vulnerable to body image dissatisfaction. Identifying a psychological variable that could help mediate the relationship between the two psychological constructs is likely to be beneficial in ameliorating the impact that body scrutinization has on body image dissatisfaction. In the current study, media internalization was hypothesized to be such a mediator. The internalization has been shown to be highly influential in body image evaluation (McCabe and Ricciardelli, 2004). With physical appearances portrayed in the media becoming the aesthetic standards against which the adolescents compared their physical appearances, these individuals were likely to experience difficulties to live up to the standards (Cash and Smolak, 2011;Witeck and Combs, 2006). Given the prominent media portraits of Thai homosexual males in the entertainment industry, together with past reports that homosexual males were particularly influenced by the media and the potential collectivist pressure for the individuals to conform to ideal group social self-presentation norms (Lanzieri and Hildebrandt, 2016), the role of media internalization in homosexual Thai males should be of particular significance.
For the above reasons, the objective of the current study was to evaluate whether internalized media influence would mediate Thai homosexual male youth's body image dissatisfaction when they engaged in body scrutinization. It was hypothesized that the mediation effect would be, at least partially, significant. During the appearance scrutinization, if the homosexual male youth did not refer to ideal body standards portrayed in the media, they were likely to experience body image dissatisfaction. In contrast, the scrutinization in combination with media internalization was likely to increase body image dissatisfaction.

Participants
Participants were 114 homosexual male youths aged 18-24 years (M = 20.88, SD = 2.03). Their averaged Body Mass Index (BMI) was kilograms (M = 23.13 SD = 5.1). Participants were recruited through the Rainbow Sky Association of Thailand's website and Facebook groups for Thai homosexual males. Individuals with an illness/injury resulting in body impairment or those undergoing counseling and/or psychotherapy were excluded.

Instruments
After responding to the demographic questions together with The Sell Assessment of Sexual Orientation (Sell, 1996), participants responded to the measures of the three study variables:

Body Image Dissatisfaction
Mazzeo's 10-item Body Dissatisfaction Scale (Mazzeo, 1999), as translated into Thai by Dejitthirat and Sakworawich (2004), was used to measure the participants' body image dissatisfaction. Participants indicated the frequency with which they experienced the feeling of the dissatisfaction (e.g. "I feel dissatisfied with my body as reflected in the mirror" and "I feel dissatisfied with my body and I should change myself") on a 5-point Likert-type scale, ranging from "Not at All" to "Always". The total score was calculated by combining the scores from all items, which were all positively worded, with a higher total score indicating higher body dissatisfaction. The scale had high reliability, with the Cronbach's alpha of .91 in the present study.

Body Scrutinization
McKinley and Hyde's 8-item Body Scrutinization Subscale of the Objectified Body Consciousness Scale (OBS) (McKinley and Hyde, 1996), as translated by Pisitsungkagarn et al. (2014), was used to measure the degree to which the participants were preoccupied about and examine their physical appearance. The participants indicated their agreements to the statements (e.g., "During the day, I think about how I look many times" and "I often worry about whether the clothes I am wearing make me look good."). The participants responded to the questions by indicating their agreements on a 6-point Likert-type scale, ranging from "Strongly Disagree" to "Strongly Agree". Reversal scoring was applied to two negatively worded items. The total score was calculated by combining the scores from all items, with a higher total score indicating higher body scrutinization. The scale had acceptable reliability, with the Cronbach's alpha of .78 in the present study.

Media Internalization
Heinberg et al.'s 7-item Sociocultural Attitude Toward Appearance Questionnaire (SATAQ-Internalization) (Heinberg et al., 1995), as translated into Thai, was used to measure the degree to which the participants internalized the ideal body image transmitted by the media. The participants indicated their agreements to the statements (e.g. "The appearance of people in the media reflects the appearance I desire "I tend to compare my body to people in magazines and on TV." And I do not wish to look like the models in the magazines.") on a 5-point Likert-type scale, ranging from "Strongly Disagree" to "Strongly Agree." Reversal scoring was applied to one negatively worded item. The total score was calculated by combining the scores from all items, with a higher total score indicating higher media internalization. The scale had high reliability, with the Cronbach's alpha of .82 in the present study.

Data Collection
Data collection commenced only after an institutional ethical review was obtained. The project ethical code was 144.1/60. Participants took approximately 15-20 minutes to respond to the online questionnaires.    Table 1 presents the associations between the three study variables. As hypothesized, body scrutinization was found to have significant and positive correlation with body image dissatisfaction (r = .51, p < .441). Media Internalization was found to be significantly and positively correlated with both body scrutinization (r = .53, p < .001) and body image dissatisfaction (r = .46, p < .001).

Results
Based on Baron and Kenny's Mediational Analysis (Baron and Kenny, 1986), media internalization was demonstrated to be a significant mediator in the relationship between body scrutinization and body dissatisfaction. Firstly, body scrutinization was significantly and positively correlated with body dissatisfaction. Secondly, body scrutinization was significantly and positively associated with media internalization. Thirdly, body scrutinization together with the media internalization significantly predicted body dissatisfaction. The regression coefficient of body scrutinization in directly predicting body dissatisfaction was r = .534 but reduced to r = .425 with media internalization being included in the model. Hence, findings showed that media internalization partially mediated the relationship between body scrutinization and body dissatisfaction. The mediation model accounted for approximately 34% of the variance in body dissatisfaction.

Discussion
The current study aimed to investigate the relatively under-researched area of factors contributing to body dissatisfaction in homosexual male adolescents. We selected Thai homosexual adolescents as a relevant sample for the study. Given the relative acceptance in Thai culture of homosexuality (Beren et al., 1996), we found that the degree to which homosexual males were portrayed in the media was relatively high (Lanzieri and Hildebrandt, 2016) and justified empirical examination of media influence in the internationalization of homosexual males' body image ideal. Additionally, because of the relative acceptance, these individuals were less likely to be stigmatized but more open in their reflection of factors that contributed to body dissatisfaction.
Previous research has established that critical body scrutinization is significantly associated with body dissatisfaction (McCabe and Ricciardelli, 2004), and it is clear that adolescents are particularly vulnerable to both the scrutinization and the ensuing dissatisfaction. With their cognitive development being in the formal operation stage, the degree to which adolescents would scrutinize their physical appearances in anticipation of others' evaluations of their own appearances was likely to be heightened. In the current study, attempts were made to identify potential solutions to alleviate this problem. We hypothesized that media internalization significantly mediated the relationship between body scrutinization and dissatisfaction.
Using a mediational analysis, our findings based on questionnaire responses of 140 Thai homosexual male adolescents supported this hypothesis. Support was obtained also for the rationale for the study, which was to find an alternative strategy for alleviating the problem of body image dissatisfaction. The partial mediation of media internalization was confirmed in the positive correlation between body scrutinization and body dissatisfaction in the participants.
Prior to discussing the mediating role of media internalization, it is worth examining our data from homosexual Thai male youth. The current findings suggested that, even when their BMI fell within the normal range, the participants occasionally experienced body image dissatisfaction. This confirmed previous findings from Western cultures that reported such experiences in homosexual males (Ojanen, 2009). With the debilitating outcomes of the dissatisfaction, both from the physical and psychological perspectives, findings from the current study suggest that male homosexual youth is the group that warrants attention for the prevention and amelioration of body dissatisfaction.
The patterns of the current findings regarding Thai homosexual male youth were comparable to those reported in heterosexual females in Western cultures. To begin with, body scrutinization was significantly associated with body dissatisfaction (Martins et al., 2007). Regardless of whether they are heterosexual females or homosexual males, the more the individuals scrutinize their physical appearance, the more likely will they perceive their own physical flaws and become dissatisfied with their physical appearance (Fitzsimmons-Craft et al., 2015). Specifically, and as hypothesized, media internalization mediated the relationships between body scrutinization and body dissatisfaction. The more homosexual male adolescents internalized body image ideals portrayed in the media, the more dissatisfied they were likely to become after their appearance scrutinization. This was because the mediaportrayed ideals became the norms against which the individuals evaluated their own appearances (Witeck and Combs, 2006). Body scrutinization with reference to such norms was likely to lead to body dissatisfaction for it was generally difficult for the individuals to adjust their physical appearances to be on par with the media-portrayed ideals (Aubrey, 2006;Szymanski and Mikorski, 2017). Hence, the portraits of homosexual male body image ideals appeared to have adverse impact on Thai homosexual males' body image in a similar manner as those in the Western heterosexual female counterparts.
The consistent findings that media internalization mediated the relationship between appearance scrutinization and body image dissatisfaction provides justification to extend the current knowledge in ways to reduce such internalization. In other words, such a reduction could help reduce the impact of body scrutinization on body image dissatisfaction. Various therapeutic implications, hence, could be drawn. First, strategies for reducing body image dissatisfaction in homosexual males should include the assessment of the role of media internalization. If the internalization is confirmed, empirical-based therapeutic interventions that have been shown to reduce its influence should be employed. An example included, for instance, psychoeducation. In their study of female youth (Harrison and Fredrickson, 2003) provided media literacy to female undergraduates to reduce their media internalization. Psychoeducation was shown not only to reduce the internalization but also alleviate the participants' body image dissatisfaction. Similarly, promising was the advocacy of the use of the individuals' own aesthetic standards for physical appearance evaluation, rather than adhering to the socially-prescribed ones (Posavac et al., 2001). These strategies have potentials to be transferred to reduce the impact of body scrutinization on body image dissatisfaction, through the reduction of media internalization in homosexual male youth.
Limitations of the present study include the following. First, the findings obtained was drawn entirely from Thai homosexual males. Whereas the relative acceptance of the Thai culture toward sexual minorities should have helped our participants to volunteer information about their sexuality and factors relevant to body dissatisfaction, the levels of acceptance cannot be assumed in other collectivistic cultures. Therefore, despite their replications of findings from female heterosexual youths, the degree to which the current findings can be generalized to homosexual males from other cultures remains open for further investigations. Additionally, this initial study focused on Thai homosexual male youth in general. However, there are various refined subtypes of homosexual males in Thailand (e.g., Thai Kratoey, Lady boy, Bisexual men). Variations may exist in the media internalization and body dissatisfaction of these subtypes.
In conclusion, future studies would benefit from examining the mediating roles of media internalization in relationships between body scrutinization and body dissatisfaction in sexual minorities from various cultural backgrounds. Attention should be given to examine subtypes of the sexual orientations. Additionally, the utilization of an experimental research design would help further clarify the causal associations that body scrutinization and media internalization had with body image dissatisfaction. Lastly, it would be highly beneficial to examine the impact of intervention programs aiming at reducing the negative impacts of media internalization on male homosexual youth and relevant outcomes on their body dissatisfaction.